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Urine analysis

Urine analysis. Dr. Usha. Introduction . Urine is formed in the kidneys, is a product of ultrafiltration of plasma by the renal glomeruli. Collection of urine. Early morning sample-qualitative Random sample- routine 24hrs sample- quantitative Midstream sample-UTI Post prandial sample-D.M.

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Urine analysis

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  1. Urine analysis Dr. Usha

  2. Introduction • Urine is formed in the kidneys, is a product of ultrafiltration of plasma by the renal glomeruli.

  3. Collection of urine • Early morning sample-qualitative • Random sample- routine • 24hrs sample- quantitative • Midstream sample-UTI • Post prandial sample-D.M

  4. 24 hour urine sample • For quantitative estimation of proteins • For estimation of vanillyl mandelic acid, 5-hydroxyindole acetic acid, metanephrines • For detection of AFB in urine • For detection of microalbuminuria

  5. Urine examination • Macroscopic examination • Chemical examination • Microscopic examination

  6. Macroscopic examination • Volume • Color • Odour • Reaction or urinary pH • Specific gravity

  7. Urinary volume • Normal = 600-1550ml • Polyuria- >2000ml • Oliguria-<400ml • Anuria-complete cessation of urine(<200ml) • Nocturia-excretion of urine by a adult of >500ml with a specific gravity of <1.018 at night (characteristic of chronic glomerulonephritis)

  8. Causes of polyuria • Diabetes mellitus • Diabetes insipidus • Polycystic kidney • Chronic renal failure • Diuretics • Intravenous saline/glucose

  9. oliguria • Dehydration-vomiting, diarrhoea, excessive sweating • Renal ischemia • Acute tubular necrosis • Obstruction to the urinary tract • Acute renal failure

  10. Color & appearance • Normal= clear & pale yellow • Colourless- dilution, diabetes mellitus, diabetes insipidus, diuretics • Milky-purulent genitourinary tract infection, chyluria • Orange-fever, excessive sweating • Red-beetroot ingestion,haematuria • Brown/ black- alkaptunuria, melanin

  11. Urinary pH/ reaction • Reaction reflects ability of kidney to maintain normal hydrogen ion concentration in plasma & ECF • Normal= 4.6-8 • Tested by- 1.litmus paper 2. pH paper 3. dipsticks

  12. Acidic urine • Ketosis-diabetes, starvation, fever • Systemic acidosis • UTI- E.coli • Acidification therapy

  13. Alkaline urine • Strict vegetarian • Systemic alkalosis • UTI- Proteus • Alkalization therapy

  14. Odour • Normal= aromatic due to the volatile fatty acids • Ammonical – bacterial action • Fruity- ketonuria

  15. Specific gravity • Depends on the concentration of various solutes in the urine. • Measured by-urinometer - refractometer - dipsticks

  16. Urinometer • Take 2/3 of urinometer container with urine • Allow the urinometer to float into the urine • Read the graduation at the lowest level of urinary meniscus • Correction of temperature & albumin is a must. • Urinometer is calibrated at 15or 200c So for every 3oc increase/decrease add/subtract 0.001 For 1gm/dl of albumin add0.001

  17. High specific gravity(hyperosthenuria) • Normal-1.016-1.022 • Causes All causes of oliguria Gycosuria

  18. Low specific gravity(hyposthenuria) • All causes of polyuria except gycosuria • Fixed specific gravity (isosthenuria)=1.010 Seen in chronic renal disease when kidney has lost the ability to concentrate or dilute

  19. Chemical examination • Proteins • Sugars • Ketone bodies • Bilirubin • Bile salts • Urobilinogen • Blood

  20. Tests for proteins • Test – HEAT & ACETIC ACID TEST • Principle-proteins are denatured & coagulated on heating to give white cloud precipitate. • Method-take 2/3 of test tube with urine, heat only the upper part keeping lower part as control. • Presence of phosphates, carbonates, proteins gives a white cloud formation. Add acetic acid 1-2 drops, if the cloud persists it indicates it is protein(acetic acid dissolves the carbonates/phosphates)

  21. Other tests • Sulphosalicylic acid test • Dipsticks • Esbach’s albuminometer- for quantitative estimation of proteins

  22. Causes of proteinuria • Prerenal causes-Heavy exercise,Fever,hypertension, multiple myeloma, ecalmpsia • Renal –acute & chronic glomerulonephritis,Renal tubular dysfunction,Polycystic kidney, nephrotic syndrome • Post renal- acute & chronic cystitis, tuberculosis cystitis

  23. Selective proteinuria • Nonselective proteinuria

  24. microalbuminuria • The level of albumin protein produced by microalbuminuria cannot be detected by urine dipstick methods. In a properly functioning body, albumin is not normally present in urine because it is retained in the bloodstream by the kidneys. Microalbuminuria is diagnosed either from a 24-hour urine collection

  25. Significance of microalbuminuria • an indicator of subclinical cardiovascular disease • an important prognostic marker for kidney disease • in diabetes mellitus • in hypertension • increasing microalbuminuria during the first 48 hours after admission to an intensive care unit predicts elevated risk for acute respiratory failure , multiple organ failure , and overall mortality

  26. Bence Jones proteins • These are light chain globulins seen in multiple myeloma, macroglobulimias, lymphoma. • Test- Thermal method(waterbath): Proteins has unusual property of precipitating at 400 -600c & then dissolving when the urine is brought to boiling(1000c) & reappears when the urine is cooled.

  27. Test for sugar • Test-BENEDICT’S TEST(semiquantitative) • Principle-benedict’s reagent contains cuso4.In the presence of reducing sugars cupric ions are converted to cuprous oxide which is hastened by heating, to give the color. • Method- take 5ml of benedict’s reagent in a test tube, add 8drops of urine. Boil the mixture. • Blue-green= negative • Yellow-green=+(<0.5%) • Greenish yellow=++(0.5-1%) • Yellow=+++(1-2%) • Brick red=++++(>2%)

  28. Benedict’s test • Detects all reducing substances like glucose, fructose, & other reducing sustances. • To confirm it is glucose, dipsticks can be used (glucose oxidase)

  29. Causes of glycosuria • Glycosuria with hyperglycaemia- diabetes,acromegaly, cushing’s disease, hyperthyroidism, drugs like corticosteroids. • Glycosuria without hyperglycaemia- renal tubular dysfunction

  30. Ketone bodies • 3 types • Acetone • Acetoacetic acid • β-hydroxy butyric acid • They are products of fat metabolism

  31. Rothera’s test • Principle-acetone & acetoacetic acid react with sodium nitroprusside in the presence of alkali to produce purple colour. • Method- take 5ml of urine in a test tube & saturate it with ammonium sulphate. Then add one crystal of sodium nitroprusside. Then gently add 0.5ml of liquor ammonia along the sides of the test tube. • Change in colour indicates + test

  32. Causes of ketonuria • Diabetes • Non-diabetic causes- high fever, starvation, severe vomiting/diarrhoea

  33. Bilirubin • Test- fouchet’s test. • Causes • Liver diseases-injury,hepatitis • Obstruction to biliary tract

  34. Urobilinogen • Test- ehrlich test • Causes-hemolytic anemia's • Bile salts- Hay’s test Cause- obstruction to bile flow (obstructive jaundice)

  35. Blood in urine • Test- BENZIDINE TEST • Principle-The peroxidase activity of hemoglobin decomposes hydrogen peroxide releasing nascent oxygen which in turn oxidizes benzidine to give blue color. • Method- mix 2ml of benzidine solution with 2ml of hydrogen peroxide in a test tube. Take 2ml of urine & add 2ml of above mixture. A blue color indicates + reaction.

  36. Causes of hematuria • Pre renal- bleeding diathesis, hemoglobinopathies, malignant hypertension. • Renal- trauma, calculi, acute & chronic glomerulonephritis, renal TB, renal tumors • Post renal – severe UTI, calculi, trauma, tumors of urinary tract

  37. Microscopic examination • Microscopic urinalysis is done simply pouring the urine sample into a test tube and centrifuging it (spinning it down in a machine) for a few minutes. The top liquid part (the supernatant) is discarded. The solid part left in the bottom of the test tube (the urine sediment) is mixed with the remaining drop of urine in the test tube and one drop is analyzed under a microscope

  38. Contents of normal urine m/s • Contains few epithelial cells, occasional RBC’s, few crystals.

  39. Crystals in acidic urine Uric acid Calcium oxalate Cystine Leucine Crystals in alkaline urine Ammonium magnesium phosphates(triple phosphate crystals) Calcium carbonate Crystals in urine

  40. crystals

  41. casts • Urinary casts are cylindrical aggregations of particles that form in the distal nephron, dislodge, and pass into the urine. In urinalysis they indicate kidney disease. They form via precipitation of Tamm-Horsfallmucoprotein which is secreted by renal tubule cells.

  42. Acellular casts Hyaline casts Granular casts Waxy casts Fatty casts Pigment casts Crystal casts Cellular casts Red cell casts White cell casts Epithelial cell cast Types of casts

  43. Hyaline casts • The most common type of cast, hyaline casts are solidified Tamm-Horsfall mucoprotein secreted from the tubular epithelial cells • Seen in fever, strenuous exercise, damage to the glomerular capillary

  44. Granular casts • Granular casts can result either from the breakdown of cellular casts or the inclusion of aggregates of plasma proteins (e.g., albumin) or immunoglobulin light chains • indicative of chronic renal disease

  45. Waxy casts • waxy casts suggest severe, longstanding kidney disease such as renal failure(end stage renal disease).

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